Early Psoriasis Diagnosis Can Prevent Symptoms from Worsening

Psoriasis is a chronic autoimmune condition that affects the skin, causing red, scaly patches that can be itchy and painful. Hormonal changes during menopause can influence the immune system. “Subsequently, psoriasis can first occur during menopause, but menopause can also make existing psoriasis worse,” says Shari Lipner, MD, PhD, associate professor of clinical dermatology at Weill Cornell Medicine. Even if psoriasis was well-managed in the past, lower estrogen levels may reduce the skin’s natural defenses, resulting in drier, more inflamed skin, which can exacerbate symptoms. Understanding how psoriasis and menopause intersect may be instrumental in managing your health and quality of life.

See a Dermatologist

If you suspect you have psoriasis or notice changes in your skin after menopause, it’s important to consult a dermatologist. Early diagnosis and treatment can prevent symptoms from worsening. “Psoriasis can also resemble other skin diseases. A board-certified dermatologist can diagnose your skin condition and give you the most appropriate treatment. Less-severe psoriasis can be treated with topicals, while moderate-to-severe psoriasis may necessitate systemic medication,” says Dr. Lipner.

Psoriatic Arthritis

One of the more serious conditions associated with psoriasis is psoriatic arthritis (PsA), which causes joint pain, stiffness, and swelling. Up to 30 percent of people with psoriasis develop PsA. For postmenopausal women, the risk may increase due to age-related joint changes and declining estrogen, which plays a protective role in joint health. If you experience joint discomfort alongside psoriasis flare-ups, it’s important to consult a rheumatologist, as untreated PsA can lead to permanent joint damage.

Psoriasis Treatment

Dermatologists typically oversee psoriasis care. Treatment plans are based on the severity of symptoms, and include topical therapies, oral systemic drugs, and biologic systemic medications used alone or in combination.

Topical Treatments

Corticosteroids: These are the most commonly prescribed topical medications for mild-to-moderate psoriasis. Examples include hydrocortisone and clobetasol. “These medicines are effective for patients with thin lesions and those with psoriasis that is not widespread. They are very safe when used under the direction of a board-certified dermatologist,” says Dr. Lipner. Side effects of long-term use may include skin thinning and broken blood vessels.

Vitamin D analogs: Calcipotriol (Dovonex) slows skin cell growth. “This may also be used with topical steroids. In rare cases it may cause skin irritation,” says Dr. Lipner.

Moisturizers: Emollients like CeraVe, Eucerin, and Aveeno are recommended to keep skin hydrated and reduce scaling. Some moisturizers contain salicylic acid, which can help remove scales.

Calcineurin inhibitors: Tacrolimus (Protopic) and pimecrolimus (Elidel) are used off-label for psoriasis on sensitive areas like the face or genitals. When a doctor prescribes something off-label, they use their medical judgment to prescribe a medication in a way that differs from its official approval.

Phototherapy

This involves controlled exposure to ultraviolet (UV) light under medical supervision. UVB light therapy slows skin cell turnover and reduces inflammation. “It must be performed two to three times per week for several months,” says Dr. Lipner.

Systemic Treatments

For more severe cases of psoriasis or for patients whose psoriasis is painful and very distressing, dermatologists may prescribe systemic treatments. These treatments include traditional drugs that broadly suppress the immune system, as well as biologics, which are targeted therapies that block specific parts of the immune system. Systemic treatments are often reserved for people who have lesions on the scalp, genitals, face, or nails.

Methotrexate is a systemic treatment that slows skin cell growth and reduces inflammation. Potential side effects are liver damage, nausea, and fatigue. Regular blood tests are required. Cyclosporine is a systemic treatment that is effective for short-term use, but it can raise blood pressure and increase the risk of kidney damage.

Biologic systemic drugs are administered by injection or infusion. Examples include adalimumab (Humira), secukinumab (Cosentyx), and ustekinumab (Stelara). “Many patients can get almost complete skin clearance with biologics, but there is increased risk of infections,” says Dr. Lipner.

Psoriasis and Quality of Life

Living with psoriasis can be physically and emotionally challenging. Research shows that postmenopausal women with psoriasis reported higher levels of depression and anxiety, often tied to the visibility of skin lesions. Joining support groups, engaging in stress-reducing activities like yoga, and maintaining a healthy diet can all improve overall well-being. By staying informed and proactive, women can effectively manage psoriasis and remain comfortable and confident in their skin as they age.

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